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Settling An Injury Claim Advice

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By MissEdithKeeler
August 18, 2009

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Personally, I've had good luck settling insurance claims on my own. I generally get reasonable offers and co operation when dealing with insurance adjusters, so my bias is to pursue this on my own unless I run into difficulties.

I'm a claims manager for an insurance company, so here are my thoughts:

--Don't wait any longer to report your claim. Report it now. Just because you report it doesn't mean you have to settle any time soon, but the longer you wait to report the claim, the more likely it is they will scrutinize your claim that much more closely (ie, running you through their fraud (SIU) unit, requiring prior medical records, etc.)

--When you're ready, try to resolve it yourself before you secure an attorney. Settlements with an attorney are generally not significantly higher than settlements achieved without attorney representation, and you can expect to give your attorney 30% of your recovery, plus expenses up to 50% plus expenses (depending on whether or not he files suit or tries the case).

--Keep track of all expenses associated with this claim, including mileage back and forth to the doctor, any household help you've had to hire because you were unable to do chores yourself, etc. All of this is recoverable.

--Find out what the statute of limitations is in your state. This is the amount of time you have to either conclude your claim or file suit. If you don't file suit or reach a settlement before the SOL runs, you cannot pursue your claim after that.

--Typical settlements, depending on the venue, the nature of the injury, etc. can run between 2 times your medical bills plus expenses and lost wages, up to about 5x medicals plus expenses and lost wages. The difference between the medical bills and remainder is meant to compensate you for present and future pain and suffering. Typically the settlement is inclusive of medical bills; most insurance companies will either pay back your health carrier or make you responsible for that. Before you finalize any settlement, make sure you know what the expectations of your health carrier are with respect to recovery.

--Some states have Personal Injury Protection, which pays regardless of fault, and Washington state does. Depending on the laws of each state, a person on a bicycle may be covered by his own PIP coverage that he carries on his own car, or under the PIP coverage carried by the vehicle that hit him. If you haven't already done so, you may want to talk to your personal auto carrier about that. Some states, if you make a claim under your PIP coverage, this is not paid back out of any settlement you make with the at-fault party.

Also, some states that have PIP coverage have a threshold for filing a 3rd party bodily injury claim (against the at-fault party). This means that in some cases you might not be allowed to pursue that 3rd party claim unless your injury reaches a certain dollar amount or a certain percentage of permanent injury.

That's all I can think of for right now. If you have specific questions, please feel free to ask.